[CPX] 기침 cough

Approach

1. 일단 onset으로 acute, subacute, chronic을 나누기

2. Hx, PE를 통해서 impression을 잡기

3. acute cough인 경우 PE 가능성 확인해서 배제 후 URI, acute bronchitis, pneumonia D/Dx

4. chronic cough인 경우 기본검사들을 통해서 D/Dx, 또는 empirical Tx를 통해서 D/Dx

5. 아래 표에 있는 Tx 시행

 

 

 

 

 

 

 

 

History

Onset

- acute : 3주 이하 / URI, pneumonia, PTE, CHF

- subacute : 3-8주 / post-infectious cough

- chronic : 8주 이상

* common : UACS, Cough variant asthma, GERD, ACE-i, NAEB

* uncommon : bronchiectasis, bronchitis, pulmonary TB, CHF, ILD, lung neoplasm

Vector / Nature / Duration / Course

Factor

Ass. Sx

- Fever, Sputum (infection)

- Post nasal drip, nasal obstruction (UACS)

- Epigastric pain, dysphagia, acid regurgitation (GERD)

- Weight loss, night sweat, mild fever, Hemoptysis (TB, cancer)

- Dyspnea, chest discomfort, tachycardia (CHF)

Medication : ACE-i 사용 여부

Hx : HTN, DM, TB, Hepatitis / sinusitis / rhinitis, asthma, atopic ds

FHx : 가족 중에 rhinitis, asthma, atopic ds 있는지

SHx : smoking, occupation

 

PE

 

HEENT

- post-nasal drip / cobblestone appearance

- sinus tenderness

- neck vein distention

Lung

- wheezing

- crackle / rale

Heart

- S3 gallop

Extremities

- clubbing

 

Diagnostic plan 

 

Chronic cough

기본검사

(1) Chest PA : lung cancer, TB, bronchiectasis, pneumonia, aspiration, sarcoidosis

- chronic cough의 most common cause를 감별할 수는 없지만 lung의 structural dz R/O

(2) Rhinolaryngoscopy, PNS x-ray : UACS

(3) Spirometry, methacholine bronchial provocation test : Asthma 

(4) Sputum analysis for eosinophil : NAEB

추가검사

(1) GFS, 24hr pH monitoring, dual pH monitoring

(2) chest CT

(3) bronchoscopy

(4) cough sensitivity (capsicin cough provocation test)